Survival from Maternal Cardiac Arrest Complicating Coronavirus Disease 2019

Introduction. Coronavirus disease 2019 (COVID-19) has been linked to significant cardiovascular complications such as cardiac arrest, which are associated with a poor prognosis in adults. Little is known about the cardiac complications, specifically cardiac arrest, of COVID-19 during pregnancy and postpartum periods. Case. We present a case of survival and full neurological recovery after maternal cardiac arrest associated with COVID-19 in a postpartum female. Her postpartum course was also associated with seizures attributed to posterior reversible encephalopathy syndrome. After 19 days in the hospital, she was discharged home neurologically intact. Conclusion. More information is needed to determine the range of short- and long-term cardiac complications that may be associated with COVID-19 during pregnancy and postpartum. Additionally, pregnant patients with COVID-19 may be more likely to survive cardiac arrest compared to the general population.

Intermittent and Transient Hypotension-related Anterior Cord Syndrome following Elective Cervical Spine Surgery: A Case Report

Introduction: Anterior cord syndrome (ACS) is a type of incomplete spinal cord injury caused by either direct compression of the anterior spinal cord, or by ischemia of the anterior spinal artery. This phenomenon has neither been described transiently nor intraoperatively. Case Report: We describe the case of a 61-year-old male who developed intermittent and transient anterior spinal cord syndrome secondary to hypotension related hypoperfusion of the anterior spinal artery after elective cervical spine surgery. Through close blood pressure monitoring and intensive care unit support, the patient regained full neurological recovery. Conclusion: Anterior spinal cord syndrome is a rare condition affecting the anterior 2/3 of the spinal cord, resulting in incomplete paralysis. Blood flow can be disrupted through the anterior spinal artery, either through thrombosis or hypotension. We describe our rare case so that surgeons may recognize this potentially devastating condition. Keywords: Spine, hypoperfusion, hypotension, cord injury, anterior cord syndrome.

Preoperative percutaneous carotid artery recanalization in a patient with aortic dissection type A

Management of patients with acute type A aortic dissection (ATAAD) presenting with cerebral malperfusion due to carotid artery obstruction is still a major challenge and often associated with poor prognosis despite successful surgical aortic repair, due to prolonged cerebral perfusion deficit. Here, we present the first report regarding successful percutaneous recanalization of an internal carotid artery occlusion in the setting of an ATAAD prior to open surgical aortic repair with excellent clinical outcome after three year follow-up, including almost full neurological recovery.

Total en bloc spondylectomy is worth doing in complete paralysis spinal giant cell tumor, a minimum 1-year follow-up

Objective: To investigate the neurological recovery of Frankel A spinal giant cell tumor (GCT) patients after they had received a Total En Bloc Spondylectomy (TES). Materials and Methods: We retrospectively recorded data of three patients (two females) with mobile spine GCT (T6, T10, and L2) Enneking stage III with complete paralysis before surgery, who had undergone TES in our institute from January 2018 to September 2020. The duration of neurologic recovery to Frankel E was the primary outcome. The intra-operative blood loss, operative time, operative-related complications, and the local recurrence were the secondary outcomes. Results: The duration of suffering from Frankel A to TES surgery was 2 months for the T6 patient, 3 weeks for the T10 patient, and 1 month for the L2 patient. Three patients had achieved full neurological recovery to Frankel E within 6 months after TES (T6 for 5 months, T10 for 3 months, and L2 for 3 months). The average blood loss was 2833.33 ml and the mean operative time was 400 min. Up until the last follow-up (13–25 months), no evidence of local recurrences had been found in any of the three patients. Conclusion: Frankel A spinal GCT patients can achieve full neurological recovery after TES, if the procedure is performed within 3 months after complete paraplegia. TES can effectively control any local recurrences.

Evolving Cognitive Dysfunction in Children with Neurologically Stable Opsoclonus–Myoclonus Syndrome

Cognitive and acquired neurodevelopmental deficits have been reported in children with opsoclonus–myoclonus syndrome (OMS) and are known to be associated with more severe and relapsing disease course. However, there is a paucity of data regarding cognitive dysfunction in children with stable neurological disease. We report three children with OMS and evolving cognitive dysfunction in the context of a mild disease course. The children’s ages at disease onset were between 17 and 35 months and they were followed up for 4–10 years. Neuroblastoma was identified in one child. OMS severity scores ranged between 8 and 12/15 at presentation. They underwent immunotherapy and all were in remission by 7 months (range 4–13 months), with treatment maintained for 1 year. One child remained relapse-free, while two others had one clinical relapse each and were immunotherapy-responsive again. In all cases, evolving cognitive dysfunction was reported despite being in remission and stable off treatment for a median of 20 months (range of 12–31 months; two OMS scores of 0/15 and one of 2/15). In children with OMS who have completed treatment and have made full or near full neurological recovery, concerns remain regarding long-term outcome in terms of future learning and cognitive development.

Retroperitoneal approach for the treatment of diaphragmatic crus syndrome: technical note

OBJECTIVEMyelopathy selectively involving the lower extremities can occur secondary to spondylotic changes, tumor, vascular malformations, or thoracolumbar cord ischemia. Vascular causes of myelopathy are rarely described. An uncommon etiology within this category is diaphragmatic crus syndrome, in which compression of an intersegmental artery supplying the cord leads to myelopathy. The authors present the operative technique for treating this syndrome, describing their experience with 3 patients treated for acute-onset lower-extremity myelopathy secondary to hypoperfusion of the anterior spinal artery.METHODSAll patients had compression of a lumbar intersegmental artery supplying the cord; the compression was caused by the diaphragmatic crus. Compression of the intersegmental artery was probably producing the patients’ symptoms by decreasing blood flow through the artery of Adamkiewicz, causing lumbosacral ischemia.RESULTSAll patients underwent surgery to transect the offending diaphragmatic crus. Each patient experienced substantial symptom improvement, and 2 patients made a full neurological recovery before discharge.CONCLUSIONSDiaphragmatic crus syndrome is a rare or under-recognized cause of ischemic myelopathy. Patients present with episodic acute-on-chronic lower-extremity paraparesis, gait instability, and numbness. Angiography confirms compression of an intersegmental artery that gives rise to a dominant radiculomedullary artery. Transecting the offending diaphragmatic crus can produce complete resolution of neurological symptoms.

Management of paediatric humeral shaft fractures and associated nerve palsy

Purpose The aim of this study is to review the management of all paediatric humerus diaphyseal fractures treated at a single institution over a 20-year period. Methods Retrospective review from between 1996 and 2016 identified 96 humerus shaft fractures in paediatric patients (0 to 17 years). After excluding those deceased from inciting trauma, pathological and perinatal fractures, 80 patients remained for analysis. Data collected included age, fracture type, displacement, nerve palsy, treatment, complications and time to union. Radiographs were reviewed at the time of injury and at latest follow-up. Results Of 80 paediatric humeral diaphyseal fractures, 65 (81%) were treated with immobilization. In all, 15 (19%) fractures were treated with surgical stabilization. Most common indications were fracture displacement, open fractures and to improve mobilization in patients with multiple injuries. Fractures were stabilized with a plate (eight), flexible nails (five), external fixation (one) and percutaneous pinning (one). The operative group, compared with the nonoperative group, was older, had more high-energy mechanisms, more open fractures and increased fracture displacement. All patients in the nonoperative and operative groups went on to union with minimal complications. A nerve palsy was present in five patients (6%)with three of the five involving the radial nerve (4%). All nerve palsies were observed and had full neurological recovery. Conclusion Over a 20-year period nonoperative management of paediatric humerus shaft fractures was successful in the majority of patients. Operative stabilization, when rarely indicated, had a low complication rate and improved radiographic alignment. All nerve injuries fully recovered without surgical intervention. Level of evidence IV